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25 July 2016
Obese patients with type 2 diabetes in New Zealand have had good long-term results after weight loss surgery, according to a new study.
The findings support other studies that indicate weight loss surgery is an effective and durable treatment for obesity associated with type 2 diabetes.
Wellington Hospital endocrinologist Dr Richard Carroll recruited 120 New Zealanders who had bariatric surgery at least five years ago to take part in the study as part of a Health Research Council of New Zealand (HRC) clinical research training fellowship. The HRC-funded study is one of the first to look at the long-term effects of bariatric surgery in obese patients.
Dr Carroll and his supervisor, fellow Wellington endocrinologist Associate Professor Jeremy Krebs, collaborated with New Zealand bariatric surgery pioneer Professor Richard Stubbs on the study. Their results show that patients lost on average 25 to 30 per cent body of their body weight following gastric bypass surgery, and maintained this weight loss over the mean follow up period of 10 years.
“What generally happens with bariatric surgery is that people lose weight very rapidly, hitting their lowest weight at about 18 to 24 months. There might be a little weight regain after this initial period, but most people maintained most or all of this weight loss over the follow up period. Any weight regain didn’t appear to relate to the length of follow up or whether people had surgery five years ago or 15 years ago – their weight appeared to be reasonably stable,” says Dr Carroll.
Although there were extremes – some people lost a huge amount of weight and maintained that while others didn’t lose much weight – no one was heavier at the final follow up appointment than they were just before surgery despite all patients being at least five years older. This, says Dr Carroll, is in “complete contrast to what we see with non-surgical interventions where weight loss is usually modest, and where any significant weight loss is all too often followed by weight regain”.
In addition to keeping the weight off, many of those who had type 2 diabetes before their bariatric surgery had their type 2 diabetes resolve after surgery.
“Of those with type 2 diabetes before surgery, 25 per cent had normal glucose tolerance by the end of the study, while 47 percent had pre-diabetes. That means 72 per cent of people had improved from having type 2 diabetes. To put that into context, only 5 to 10 per cent of patients who receive traditional medical interventions might normalise their glucose tolerance in the most rigorous clinical trials – and less than that in the real-world setting,” says Dr Carroll.
A large proportion of the 28 per cent of patients who still had type 2 diabetes at the end of the study also saw improvements. At the time of their surgery, more than 90 per cent of this group were on medications for their diabetes to lower glucose. However, by the time of the study follow up, only 42 per cent still needed to take these medications and only one person required insulin.
“Most of us agree that the majority of what we see early after bariatric surgery can be put down to restricting calories. However, there are some other features going on too – particularly in terms of how the body handles glucose – that are different from what we observe after non-surgical weight loss,” says Dr Carroll.
HRC Chief Executive Professor Kath McPherson says a number of diabetes and obesity societies around the world are now recommending bariatric surgery as an intervention. Because there are significant costs associated with this, it’s important to have long-term data to show that the health and economic benefits of these surgical procedures outweigh the initial expense.
“Obesity and diabetes cause significant health problems for many New Zealanders, and place a considerable strain on our health care system. Obesity is a risk factor for diabetes, cardiovascular disease, musculoskeletal disorders, and some cancers. Complications from diabetes include increased risk of cardiovascular disease, nerve damage, and damage to our organs with kidney failure being a very severe consequence. Investing in research that finds ways to prevent and address what are frequently debilitating, disabling and devastating health issues is crucial if we want fewer New Zealanders to experience these health issues and have optimal health and wellbeing,” says Professor McPherson.
In other findings, Dr Carroll found that blood pressure and lipid levels were both significantly improved by gastric bypass, and again, these benefits were still evident many years after surgery. Levels of depression were significantly reduced, while quality of life indicators such as physical function, self-esteem, and work performance all improved markedly.
On the downside, the frequency of osteoarthritis was higher after bariatric surgery than before, something Dr Carroll says likely relates to the damage done to people’s joints from their previous obesity and not the surgery. Also, 49 per cent of people were deficient in zinc at the study follow up, stressing the importance of good nutritional follow up after bariatric procedures. Dr Carroll, Associate Professor Krebs, and colleagues at the Endocrine, Diabetes, and Research Centre in Wellington Hospital are currently studying how to best correct this deficiency.
“We have an incomplete understanding of all the mechanisms that underlie the rapid increase in obesity that we’ve seen in recent years. As well as being a very effective treatment for those with established obesity and type 2 diabetes, bariatric surgery has the potential to clarify poorly understood physiological aspects of weight control. Research in this field may provide clues as to how we could prevent weight gain in the first place, or achieve better weight loss results without needing to turn to bariatric surgeons,” says Dr Carroll.
Pharmacists are the recognised medicines experts, but is New Zealand making the most of their skills?
Professor Jackie Cumming from Victoria University of Wellington has received a $1.2 million project grant from the Health Research Council of New Zealand (HRC) to explore the effects of changes to community pharmacy services in New Zealand, particularly the emphasis on extending the role of pharmacists.
“Significant changes to the role of community pharmacies in New Zealand are expected to occur over the next few years, with a view to improving access to services, keeping people well within the community, and making the most of primary health care practitioners’ skills,” says Professor Cumming.
However, despite the focus on extending community pharmacy services and roles both nationally and internationally, Professor Cumming says the overall evidence base to support this extension is not strong.
“This research will provide an in-depth understanding of whether or not extended community pharmacy services are developing as expected in New Zealand, identify what is working well and what isn’t, and the extent to which a range of health and health system outcomes are or aren’t being achieved,” she says.
There are more than 900 community pharmacies nationally, and in 2014 more than 80 per cent of registered practising pharmacists in New Zealand were employed in the community pharmacy setting.
HRC Chief Executive Professor Kath McPherson says that the role of pharmacists has historically been to dispense medicines. However, more recently the government has developed a number of key national strategies to extend this role to improve access to primary health care and deliver more preventative public health services.
“A really important part of this research is the emphasis on understanding the perspectives of people who are actively using extended community pharmacy services, especially Māori, Pacific, and lower-income New Zealanders. We need to significantly improve access to primary health care services if we are going to reduce the widening health inequalities in New Zealand,” says Professor McPherson.
The HRC has also announced funding for another project with a strong community health focus. Pacific health researcher Dr Gerhard Sundborn from the University of Auckland has received funding to determine the effectiveness of a school and community-based intervention to reduce the intake of sugar sweetened beverages (SSBs) and unhealthy weight gain in Māori and Pasifika youth.
“Sugar-sweetened beverages are the leading source of added sugar for New Zealand children, and intake of these beverages is much higher in Māori and Pacific children. A high intake of SSBs is a risk factor for obesity, type 2 diabetes, and poor oral health,” says Dr Sundborn.
“Overseas evidence shows promise that school projects can reduce SSB intake and obesity, but it’s important we show that such interventions are effective in the New Zealand context,” he says.
Professor Jackie Cumming, Victoria University of Wellington
Exploring the development and impact of changes in community pharmacy services
42 months, $1,185,380
Dr Gerhard Sundborn, University of Auckland
Communities fighting sugar in soft drinks
48 months, $1,176,875
11 July 2016
A coalition of experts on tropical infectious diseases led by University of Otago’s Professor John Crump, Co-Director of the Centre for International Health, has secured about $450,000 (NZD) to study causes of fever and how patients with fever are managed in Myanmar (formerly Burma) and the Lao Peoples Democratic Republic (Lao PDR).
The New Zealand research team includes Professor David Murdoch from the Department of Pathology, University of Otago Christchurch, and Dr James Ussher from the University’s Department of Microbiology and Immunology.
The HRC is funding the project through the e-ASIA Joint Research Program (e-ASIA JRP).
The e-ASIA JRP is a coalition of national research funding institutions from 10 Association of Southeast Asian Nations (ASEAN) countries and eight East Asia Summit participating countries, including New Zealand. Projects are required to be multilateral and to promote collaboration, innovation, and support economic development in the East Asian Region.
“New Zealand’s health research investment has traditionally been intensely focused on domestic health concerns,” says Professor Crump.
“However, in a highly interconnected world infectious disease problems are easily spread from one place to another. International collaboration is essential to find solutions to these threats.
“It is gratifying that the HRC has joined the e-ASIA JRP to help tackle infectious diseases problems of joint interest with our neighbours. We hope that this small step leads to growing opportunities for New Zealand health experts to collaborate on research of relevance to development and global health security.”
HRC Chief Executive Professor Kath McPherson says the e-ASIA program provides a significant opportunity to engage with Asia through joint international projects.
"Our involvement in this program will enable New Zealand researchers to collaborate with international research teams to the mutual benefit of the countries involved," says Professor McPherson.
The project brings world-leading infectious diseases expertise to bear on the problem of fever, a common reason to seek health care in both Myanmar and the Lao PDR.
The researchers will study treatable and preventable causes of fever in Myanmar, identifying ways to improve fever management in both Myanmar and Lao PDR.
11 July 2016
We are very pleased to announce that Mr Stacey Pene (Ngāti Kahungunu), who has been coordinating the Māori and Pacific health research portfolios since January, has been appointed as the HRC’s new Manager of Māori Research Investment.
Stacey has a Bachelor of Biomedical Sciences, majoring in functional human biology, from the University of Otago. His experience includes working as a writer, editor and project manager within the medical communications industry. He has also worked in the medical IT field, and between 2013 and 2014 was part of the HRC’s Investment Processes team, overseeing the biomedical and clinical portfolios. Before rejoining the HRC at the start of the year, Stacey had been working as a freelance writer and project manager.
Stacey can be contacted on (09) 303 5225, or by email at firstname.lastname@example.org.